Factors of selection and failure of ambulatory incisional hernia repair: A cohort study of 1429 patients.

BACKGROUND: Ambulatory surgery for incisional hernia repair (IHR) is not a widespread practice and is mainly performed for small incisional hernias.

AIM: To assess outpatient IHR practice in France and to identify predictive factors of selection and failure of ambulatory procedures.

METHOD: Surgeons of the French "Club Hernie" prospectively gathered data concerning IHR over a period of almost 5years within a nationwide database.

RESULTS: A number of patients (1429) were operated on during the period of the study. The mean age was 63.3 (22-97) years old. An ambulatory procedure was planned in 305 (21%) patients. Among these, 272 (89%) IHR were effectively performed as one-day procedures. Upon multivariate analysis, predictive factors influencing practitioners for not propose an ambulatory care were increasing age (OR 0.97, P<0.001), body mass index (OR 0.95, P<0.001), ASA grade≥III (OR 0.23, P<0.001), hernia width≥4cm (OR 0.44, P<0.001), recurrent hernia (OR 0.55, P=0.01) and a laparoscopic IHR (OR 0.54, P<0.001). A number of patients (1157) were not selected preoperatively for outpatient IHR mainly because of organizational issues or an ASA grade≥III. Medical or social reasons were the main causes of failure of initially planned ambulatory settings.

CONCLUSION: Ambulatory IHR is a safe and feasible practice subject to a good preoperative selection of the patients. Increasing age, body mass index, ASA grade≥III, hernia width≥4cm, recurrent hernia and a laparoscopic IHR were identified to be preoperative factors for not proposing an ambulatory care. One-day surgery for IHR could be systematically proposed for IHR of small incisional hernias (<4cm) in young patients with few comorbidities.